COMMENTARY

Do Patients on Meds Become Complacent About Lifestyle?

JoAnn E. Manson, MD, DrPH

Disclosures

March 27, 2020

This transcript has been edited for clarity.

Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital.

I'd like to talk with you about a recent study that addressed whether lifestyle factors change after initiating medications for hypertension or high cholesterol. There's been some concern that patients may become more complacent about lifestyle factors after starting pharmacotherapy for these conditions.

Previous studies have tended to be cross-sectional; this was the first large-scale prospective cohort study, published in the Journal of the American Heart Association and done in Finland. The Finnish Public Sector Study included more than 41,000 participants aged 40 and older who had no prior history of cardiovascular disease. Information about the initiation of medications was obtained from pharmacy claims databases, and the participants completed multiple surveys during follow-up of about 14 years about their lifestyle behaviors.

They found that among those who initiated pharmacotherapy for hypertension or elevated cholesterol, there was a tendency toward less favorable lifestyle practices. For example, there was a greater odds of becoming physically inactive or reducing physical activity level. There was also a greater odds of gaining weight and a greater risk of developing obesity during follow-up.

On the favorable side, there was a decline in cigarette smoking and alcohol consumption. However, overall the pattern was consistent with the perception that the medications were perhaps a substitute for healthy lifestyle practices as opposed to a complement to lifestyle.

It's really important that we counsel our patients about continuing to prioritize healthy lifestyle practices even after initiating these medications. There is evidence, not only now from Finland but also from some earlier studies, that is suggestive of this in the United States—data from NHANES, the Framingham Heart Study, and from Korea and other countries that in fact there may be a perception that the treatments are substitutes for healthy lifestyle behaviors.

From a population health standpoint, there are many benefits to be achieved from being regularly physically active and following a heart-healthy diet. Having healthy lifestyle practices reduces the risk for many other conditions (type 2 diabetes, cancer, osteoporotic fracture and several others). It may be helpful to our patients to work with them to encourage these lifestyle behaviors even after starting these medications, and engage the patient in shared decision-making and understanding ways that we can support them in maintaining healthy lifestyle behaviors.

Thank you so much for your attention. This is JoAnn Manson.

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